Emergence hemodynamic changes and postoperative outcomes in hypertensive patients receiving antihypertensive therapy undergoing general anesthesia: an observational study
DOI:
https://doi.org/10.18203/2320-6012.ijrms20263090Keywords:
Anesthetic modulation, Antihypertensive agents, General anesthesia, Hypertension, Perioperative care, Postoperative complicationsAbstract
Background: Hypertensive patients undergoing general anesthesia often continue antihypertensive therapy through the perioperative period, yet whether the number of preoperative antihypertensive agents predicts the need for intraoperative anesthetic modulation or postoperative outcome remains unclear. This study aimed to characterise antihypertensive medication burden, anesthetic modulation requirement and postoperative adverse events in hypertensive patients undergoing general anesthesia.
Methods: This prospective observational study enrolled 60 diagnosed hypertensive patients undergoing elective surgery at Bangladesh Medical University, Dhaka, over twelve months. Patients were grouped as normotensive, hypotensive or hypertensive according to intraoperative blood pressure deviation from baseline. Number of antihypertensive medications, frequency of anaesthetic modulation, systolic, diastolic and mean arterial pressures according to medication count and postoperative adverse events were recorded and analyzed using SPSS version 26.0.
Results: Single-drug therapy was used by 63.3% of patients, two-drug combinations by 23.3% and three or more drugs by 13.4%. Hypotensive patients most often required two episodes of anesthetic modulation (50.0%), while hypertensive patients most often required three (63.0%). Blood pressure did not differ significantly by medication count at any time point (p>0.05). Postoperative nausea and vomiting occurred in 50% of hypertensive, 33.3% of hypotensive and 9.3% of normotensive patients (p=0.007) and coughing occurred only in hypertensive patients (25%, p=0.003).
Conclusions: Antihypertensive medication count did not predict perioperative hemodynamic instability, whereas intraoperative blood pressure status was strongly associated with modulation requirement and postoperative adverse events.
References
Uddin SS, Khan MA, Karim SFE. Comparison of hemodynamic responses to use of laryngeal mask airway versus endotracheal tube in hypertensive patients. Pak Armed Forces Med J. 2012;62(3):398-403.
Colson P, Ryckwaert F, Coriat P. Renin angiotensin system antagonists and anesthesia. Anesth Analg. 1999;89(5):1143-55.
Pigott DW, Nagle C, Allman K, Westaby S, Evans RD. Effect of omitting regular ACE inhibitor medication before cardiac surgery on hemodynamic variables and vasoactive drug requirements. Br J Anaesth. 1999;83(5):715-20.
Hartle A, McCormack T, Carlisle J, Anderson S, Pichel A, Beckett N, et al. The measurement of adult blood pressure and management of hypertension before elective surgery: Joint Guidelines from the Association of Anaesthetists of Great Britain and Ireland and the British Hypertension Society. Anesthesia. 2016;71(3):326-37.
James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014;311(5):507-20.
Sanders RD. How important is peri-operative hypertension? Anesthesia. 2014;69(9):948-53.
Foëx P, Sear JW. Hypertension: pathophysiology and treatment. Contin Educ Anaesth Crit Care Pain. 2004;4(3):71-5.
Eagle KA, Berger PB, Calkins H, Chaitman BR, Ewy GA, Fleischmann KE, et al. ACC/AHA guideline update for perioperative cardiovascular evaluation for noncardiac surgery: executive summary. Circulation. 2002;105(10):1257-67.
Kellner DB, Urman RD, Greenberg P, Brovman EY. Analysis of adverse outcomes in the post-anesthesia care unit based on anesthesia liability data. J Clin Anesth. 2018;50:48-56.
Trentman TL, Thomas JK, Noble BN, Renfree KJ, Hattrup SJ. More hypotension in patients taking antihypertensives preoperatively during shoulder surgery in the beach chair position. Can J Anaesth. 2011;58(11):993-1000.
Sear JW, Howell SJ, Sear YM, Yeates D, Goldacre M, Foex P. Intercurrent drug therapy and perioperative cardiovascular mortality in elective and urgent/emergency surgical patients. Br J Anaesth. 2001;86(4):506-12.
Beattie WS, Wijeysundera DN, Karkouti K, McCluskey S, Tait G. Does tight heart rate control improve beta-blocker efficacy? An updated analysis of the noncardiac surgical randomized trials. Anesth Analg. 2008;106(4):1039-48.
Shailaja S, Srikantu J. Comparison of effect of esmolol vs esmolol and fentanyl on hemodynamic response to laryngoscopy and tracheal intubation in controlled hypertensive patients: a randomized controlled double blind study. Anesth Pain Intens Care. 2013;17(3):267-73.
Messerli FH, Rimoldi SF, Bangalore S. The transition from hypertension to heart failure: contemporary update. JACC Heart Fail. 2017;5(8):543-51.
Mohseni S, Behnam-Roudsari S, Tarbiat M, Shaker P, Shivaie S, Shafiee MA. Perioperative hypertension etiologies in patients undergoing noncardiac surgery in University Health Network Hospitals, Canada from 2015-2020. Integr Blood Press Control. 2022:23-32.
Zivanovic S, Popovic Z, Miskovic L. Assessing hemodynamic alterations in hypertensive patients during tracheal extubation. Perioper Care Med. 2023;29(3):210-5.
van Waes JA, van Klei WA, Wijeysundera DN, van Wolfswinkel L, Lindsay TF, Beattie WS. Association between intraoperative hypotension and myocardial injury after vascular surgery. Anesthesiology. 2016;124(1):35-44.
Walsh M, Devereaux PJ, Garg AX, Kurz A, Turan A, Rodseth RN, et al. Relationship between intraoperative mean arterial pressure and clinical outcomes after noncardiac surgery: toward an empirical definition of hypotension. Surv Anesthesiol. 2014;58(4):184-5.
Bijker JB, van Klei WA, Vergouwe Y, Eleveld DJ, van Wolfswinkel L, Moons KG, et al. Intraoperative hypotension and 1-year mortality after noncardiac surgery. Anesthesiology. 2009;111(6):1217-26.
Popat M, Mitchell V, Dravid R, Patel A, Swampillai C, Higgs A. Difficult Airway Society guidelines for the management of tracheal extubation. Anesthesia. 2012;67:318-40.
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